Accuracy of data in computer-based patient records

Abstract

Data in computer-based patient records (CPRs) have many uses beyond their primary role in patient care, including research and health-system management. Although the accuracy of CPR data directly affects these applications, there has been only sporadic interest in, and no previous review of, data accuracy in CPRs. This paper reviews the published studies of data accuracy in CPRs. These studies report highly variable levels of accuracy. This variability stems from differences in study design, in types of data studied, and in the CPRs themselves. These differences confound interpretation of this literature. We conclude that our knowledge of data accuracy in CPRs is not commensurate with its importance and further studies are needed. We propose methodological guidelines for studying accuracy that address shortcomings of the current literature. As CPR data are used increasingly for research, methods used in research databases to continuously monitor and improve accuracy should be applied to CPRs.

Figure 1

The variety of mechanisms by which historical facts, observations, and measurements flow into a CPR. Error can be introduced at any step.

Figure 2

Correctness is the proportion of CPR observations that are a correct representation of the true state of the world and is calculated as a/(a + b)—equivalent to positive predictive value. Completeness is the proportion of observations made about the world that were recorded in the CPR and is calculated as a/(a + c)—equivalent to sensitivity. Negative predictive value and specificity can also be derived from this table but are not measured in data accuracy because the “d cell” may be infinitely large (it is unfeasible to count the number of observations that were not made that should not have been made).